Pituitary Flashcards
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Diplopia
Diplopia - mass is extending laterally and interacting with cranial nerves to cause double vision
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Bitemporal hemianopsia
Bitemporal hemianopsia - mass is extending superiorly and interacting with the optic chiasm, causing a loss in peripheral vision
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Hydrocephalus and papilledema
Hydrocephalus and papilledema occur in superiorly extended masses due to occlusion of ventricles and resulting in increased cranial pressure
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Hypothalamic symptoms
Hypothalamic symptoms occur due to a superiorly extended mass; symptoms will involve temperature, satiety, weight, thirst etc.
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
CSF Rhinorrhea/Post-Nasal Drip
CSF Rhinorrhea will result from inferiorly extended masses as these masses can erode into the sphenoid sinus.
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Meningitis
Meningitis occurs due to a breach in the meninges and this can occur if a tumour creates a connection from the nose, mouth and sinuses in an inferiorly extended mass.
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Headaches, nausea, vomitting
General mass effect: anything that stretches the meninges can cause this
Based on the clinical symptom given, in what direction do you expect that a pituitary tumour has extended?
Nasopharyngeal mass
Inferiorly extended masses can result in a nasopharyngeal mass.
A 27 year old man is brought in to the ER after a fall off a ladder while fixing his roof. His neurological exam is normal. BP is 140/88, he is mildly obese. His head CT shows a 2 cm pituitary mass. All of the following test should be appropriate except:
a) overnight DST (dexamethasone suppression test)
b) GH and TSH levels
c) FAI (tests free testosterone) and LH
d) IGF-1
e) 8 am cortisol
b) GH and TSH levels; testing these pituitary hormones alone do not provide any answers. The target hormones should first be ordered/ordered with the pituitary hormones to provide diagnosis.
All of the following would result in an increased serum prolactin level except:
a) pregnancy
b) renal failure
c) hypothyroidism
d) heart failure
e) sarcoidosis
Answer is d) heart failure.
The kidneys are where prolactin is excreted so renal failure will increase prolactin. TRH stimulates prolactin so hypothyroidism will cause increased prolactin. Sarcoidosis can infiltrate the hypothalamus or stalk or pituitary and result in increased prolactin.
A healthy 23 year old woman has amenorrhea and galactorrhea of 2 years’ duration. Serum prolactin is 280 ng/mL (0-23). The most likely cause is:
a) primary hypothyroidism
b) use of dopaminergic drugs
c) chronic renal failure
d) suprasellar craniopharyngioma
e) a prolactin producing pituitary tumor
e) a prolactin producing pituitary tumor
If the prolactin is elevated over 100 then we are thinking a prolactin producing tumour. If the prolactin is over 100 it interferes with gonadotropins.
A 57 year old man presents with HTN, Carpal Tunnel Syndrome and is found to have enlarged hands and feet and other symptoms compatible with acromegaly. All of the following would be appropriate in working up this patient EXCEPT:
a) measuring IGF-1
b) colonoscopy
c) MRI of pituitary
d) MRI of pancreas
d) MRI of pancreas
GH is contraindicated in people with potential tumours as it will cause tumors to grow. Colon cancer is a common cancer seen in patients with acromegaly and GH would cause these tumors to grow.
